The New York Skeletal Biology and Medicine (NYSBM) is the third international conference in a series of biennial meetings that began in 2005, initially under the joint auspices of the New York Academy of Sciences and Mount Sinai School of Medicine. The target audience for this conference comprises of basic scientists, clinical investigators and clinicians with interests in diverse disciplines of endocrinology, physiology, cell biology, pathology, genetics, molecular biology, rheumatology, radiology, orthopedics and oncology as they relate to bone development, homeostasis and health. The previous conferences have had up to 200 participants, of which up to 80 experts in various areas of basic and clinical bone disease were invited to speak or chair sessions. The past years'meetings have been cherished by the participants and attendees from all parts of the world. The past meeting, in particular, featured amongst other plenary and invited lectures, Dr. Aaron Ciechanover, Nobel Laureate in Chemistry (2004) from Haifa, Israel. It also featured the Rosalyn Yalow Lecture given by John Potts (Harvard Medical School) and the Gideon Rodan Memorial Lecture given by Gerard Karsenty (Columbia). The conference now commands the reputation as being a premiere meeting in skeletal metabolism, and has therefore become an imperative. The conference provides vital insights into the mechanisms of bone development and restructuring, including cellular and mechanical triggers, receptors and signaling pathways. The past two meetings have contributed significantly to our understanding of both normative and pathologic states of bone and the skeleton. Bone cells undergo dynamic processes, where by they are influenced by genetic factors and cellular mediators. Recent findings are shaping therapeutic directions to focus on multiple modes of intervention involving anti-resorptive and importantly anabolic agents. Also significant is the role that other physiological systems or disease states such as the immune system, inflammation, diabetes, infection and cancer have on bone and musculoskeletal health. A better understanding of the fundamentals of skeletal biology, the pathophysiology associated with skeletal disease and the molecular and genetic basis of these disorders will impact on our ability to find effective treatments. The 2009 NYSMB will combine basic, clinical and translational research in a forum designed to provide the most current information on aspects of skeletal development and its relationship to bone disease and its treatment.